Many health experts say cost-containment strategies advanced by government, such as preventive and primary care, comparing drugs and treatments for effectiveness, systematic care of chronic disease, and electronic medical records, would give us better care, but would not save much money.

Existing bills do NOT incorporate measures that would effectively reduce healthcare costs, such as eliminating insurance companies (single-payer), hard government negotiation of drug prices and hospital costs, or paying doctors on salary so they have no incentives to over-treat us or under-treat us.

The main Medicare cost saving spelled out so far, eliminating overpayments to HMO-based Medicare Advantage programs, is justified but it covers less than half of the hundreds of billions in ten-year cost savings demanded from Medicare, leaving open questions about the remainder of cost savings.

The Senate Finance Committee bill, currently the center of gravity in legislative negotiations because it is the least expensive, calls for greater cost savings in Medicare payments to hospitals than in elimination of Medicare Advantage overpayments, and creates a Commission to permanently contain Medicare expenses, whose recommendations would take effect unless overruled by lawmakers.

Other proposed Medicare cost-containment measures could have uncertain outcomes, such as bundled payments to be split between doctors, hospitals and managers for individual patient episodes like hip replacements; benefits like co-ordination of care could be outweighed by aggressive cost cutting.

HR 3200’s Medicare-friendly provisions, like eliminating major cuts scheduled for Medicare doctors, eliminating co-pays and deductibles for preventive care, reducing the Part D doughnut hole, and increasing Part B and D premium assistance, may be lost as in the legislative fight to add benefits to the Senate Finance Committee bill.

I believe Medicare’s financial sustainability is best achieved by extending it to all, so the 80 % of us not needing expensive care now will pay in, and be assured that Medicare will be there when we need it.

In spite of recent news that 45,000 die each year in the US from lack of insurance, it’s clear that business and government want healthcare “reform” to control their costs while protecting and stabilizing the profits of the insurance, drug, and hospital industries. It’s not about providing everyone with comprehensive, affordable healthcare, let alone equal healthcare! It’s about forcing everyone to buy private insurance, with little assurance the insurance will cover them, or be affordable. It’s déjà vu of the bank bail-out; insurance companies will clean up. And forget undocumented workers.

Reducing healthcare costs for government and corporations is top priority. The House’s HR 3200 says half of the $1 trillion 10-year cost would come from savings in Medicare. Obama’s health speech said most of his $900 billion plan would come from savings in Medicare and Medicaid. And Max Baucus’ Senate Finance Committee plan doesn’t require any payment from companies that don’t offer insurance, unless the workers qualify for the skimpy government assistance.

Business and government are unwilling to do the things that could really control costs: (1) eliminate private health insurance with its outrageous profits and administrative costs (single payer), (2) negotiate drug prices and hospital charges, and (3) put doctors on salaries so their practices are no longer businesses with built-in incentives to either over-treat us or under-treat us.

So how do they plan to save at least $400-500 billion over ten years? Obama talks about eliminating the overpayments to HMO-based Medicare Advantage plans, which is good, but CBO estimates this will save only $150 billion. Obama talks about preventive and primary care, comparing drugs and treatments for effectiveness, systematic care of chronic disease, and electronic medical records. These would give better care, but don’t save much money, say knowledgeable experts.

Other suggested Medicare savings include an independent agency to set doctor and hospital rates; and encouraging or forcing doctors, hospitals, and nursing homes into accountable care organizations that would receive lump-sum payments for patients’ procedures like hip replacements or cardiac surgery, and be rewarded for cost savings and meeting care standards. HR 3200’s Medicare-friendly provisions, like eliminating major cuts scheduled for Medicare doctors, eliminating co-pays and deductibles for preventive care, reducing the Part D doughnut hole, and increasing Part B and D premium assistance, may be lost as Senator Baucus’ cheaper plan becomes the center of negotiation. However, without single payer, negotiated drug and hospital prices, and salaried doctors, the Medicare savings these plans need would require ending Medicare’s “entitlement” status; its budget would no longer grow automatically as enrollment increases. This is a major threat.

Even as Obama, Baucus, and Pelosi assure us that single payer is off the table, people continue to demand it. Obama officials, who organized the huge Sept. 2 rally at San Francisco City Hall for the public option, were openly hostile to the many people with single payer signs, asking some to move so as to “not block the view.” But the people whom the Obama officials brought to the rally loved the single payer signs, and cheered the people carrying them (including Gray Panthers).

Many public option supporters really wanted Single Payer.

Whatever private-insurance-based plan is chosen, it will neither provide care nor contain costs, as the Massachusetts plan shows. Meanwhile we must demand the plan include the Kucinich amendment so states can have their own single payer plans. This struggle will continue.